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As Iran's economy has faltered and the cost of living has skyrocketed, Iranians living with HIV/Aids are struggling for survival, Roxana Saberi reports.

"Every week, I hear about someone with HIV dying," says an HIV-positive woman who spoke on condition of anonymity. "Healthy people have a lot of problems these days, too, but we're less capable of dealing with them."

She is one of an estimated 96,000 Iranians who the Joint United Nations Programme on HIV/Aids (UNAIDS) and Iran's government say have HIV; only around a quarter of them have been identified.

Some observers suspect Tehran has underestimated these statistics to avoid darkening the country's Islamic credentials - a charge government officials deny.

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The government was supposed to give us insurance and a monthly stipend, but it didn't”

End QuoteAmirHIV-positive Iranian

In the 2000s, Iran became known as the region's leader in the fight against Aids. Each year, the government allocates millions of dollars to prevent and manage the disease, and government-sponsored clinics across the country help battle it.

Yet several HIV/Aids activists and Iranians infected with the virus argue that efforts to control the epidemic have suffered major setbacks in recent years, mostly because of the weakening economy and the widespread stigma of the illness.

"Many people with HIV can't find work and are sleeping on the streets," says Amir, an HIV-positive Iranian who agreed to speak only under a pseudonym. "The government was supposed to give us insurance and a monthly stipend, but it didn't. Thank God I have a job and a roof over my head."

Amir does not have to pay for antiretroviral drugs, which Iran's government provides for free. He says, though, that their quality has deteriorated and he cannot afford routine exams to check the status of HIV in his blood.

"For a time, I was even given drugs that had expired," he adds. "We also couldn't get influenza vaccinations this year. I don't know if these problems are due to sanctions."

Sanctions bite

UN, EU and US sanctions targeting Iran's nuclear programme exempt trade in medicine for humanitarian reasons. But with banking restrictions, high inflation, and the plunging value of Iran's currency, many drugs are costly and hard to find in Iran.

Many of the cases of HIV/Aids in Iran are attributed to drug use

"With sanctions, groups like Iranians living with HIV are usually the first ones affected," says Dr Hamidreza Setayesh, a UNAIDS official for the Middle East. "Fortunately they have enough imported medications so far, but sooner or later they will be affected because the stock will finish."

Another challenge, Dr Setayesh says, is that the government has been cutting its HIV-AIDS budget, including funding for harm reduction among people who inject drugs, free condoms and birth-control programs. He attributes the cuts to inflation and a change in the country's family planning policies.

Iran's Supreme Leader, Ayatollah Ali Khamenei, has called the government's efforts to limit population growth a "mistake."

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Many young Iranians have premarital sex, so HIV is passing from person to person before marriage”

End QuoteDr Jamal HekmatIranHIV.com

"The previous course included lessons on safe sex," says Dr Jamal Hekmat. "It's a shame it was cancelled."

Dr Hekmat has been educating Iranians about the virus through his Farsi-language website, IranHIV.com.

Iran's government filters the site inside Iran, he says, and last week it was hacked for the second time. Every day, Iranians come to the site to ask basic questions about HIV.

"Unfortunately they don't know how to protect themselves," Dr Hekmat says. "Many young Iranians have premarital sex, so HIV is passing from person to person before marriage."

Iran's HIV epidemic is concentrated among the country's intravenous drug users and prisoners, but Aids experts warn that the virus will spread more widely if the country does not focus more on high-risk sexual behaviours, like unprotected sex and prostitution.

Arash Alaei and his brother Kamiar pioneered a national HIV/Aids response in Iran

The government has set up 21 centres offering HIV/Aids prevention and counselling to "vulnerable women", but Dr Arash Alaei, an HIV/Aids specialist, says more must be done.

"They need to improve outreach to sex workers, give them access to condoms, and have screening tests," he adds.

Dr Alaei believes that Iran's fight against Aids has become less progressive under President Mahmoud Ahmadinejad, who chairs a council that removed World Aids Day from Iran's national calendar last year.

In 2009, a court convicted Alaei and his brother, Kamiar, of "having relations with hostile governments" and "tainting Iran's reputation" - charges they say stem from their work on HIV/Aids.

They were released in 2011 after serving part of their terms in Tehran's Evin prison.

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